I actually think Hospice people are Angels on Earth.

you probably know when its time
at that point
load them up with morphine
not a hot shot
just speed things up

So I dont disagree at all. I think it is safe to say we keep our comfort care patients pretty well loaded up. I am certainly fine with that, but I wont keep pushing past the point of loaded up to the point of making them stop breathing or stopping the heart.

yes sir

Thanks for what you do, if all healthcare workers were like you, and the doctor we would all be better off for it. I don't want anyone to have to suffer needlessly. Thanks to both of you for being so caring

So overall, based off all the responses, it is safe to say most are comfortable with natural progression of death AS LONG AS their loved one is 100% comfortable and I completely agree with this and am on board with providing this exact care. It is actually enlightening to see these responses. Thank you to everyone that has shared stories of losing their loved ones thus far. I didn't respond to them all, but I read them. I am sorry for everyone's losses and the toughness of going through these situations with your loved ones.

To the doc who responded, I appreciate and respect everything said. I agree with everything posted but it wasn't unexpected. I think most that share the same work and see what we see on a daily basis, have the same mindset. Hence the reason to get the opinions from those that don't necessarily see what we see. I appreciate what you do and will always have the respect for MD's who have to have the tough conversations with their patients and the family members. So thank you for what you do and you mindset around this.

Didn't mean to get deep on this one or before the weekend. Just got to thinking and wanted some THF wisdom since I have had these conversations with other healthcare workers and we are all of the same mindset around this topic, never really had a conversation about it outside of the medical world.

I am, our family is dealing with "last year(s) of life" situations right now.

I do not post about deep personal family issues, but I will this time.

Our mom of 91 has dementia, she is declining, and so is our dad, also 91 years of age.

Our family is split on putting our mom in a nursing home/healthcare facility.

She is already on hospice.

It is "ripping our family apart," literally.

The pain we are going through, and ME, trying to be rational and also be the peacekeeper, is brutal. I break down regularly.

I've never been through this much emotional pain. I feel like crying right now.

I adore my mom, and her "best days" are NOT that good. Her bad days, like yesterday, are horrible. I hanging on by a thread, barely.

I've accepted I want the Lord to come and take my parents. I can't believe I've crossed over to praying for it. They are suffering, and in turn, the family is, because our parents are dying, and yet, my siblings have learned to literally hate each other.

Yes, I wish we could bring peace to those who need it, or to ourselves.

* Anyone who has a loved one who gets sick or really old, seeing them pass "quickly," is a blessings. Lingering, is torture!

"Please Lord in Heaven, please give my parents peace, and with luck, over time, the peace will enter the hearts of my siblings who have forgotten how to love each other...please Lord, please, I'm begging you!" IN65/joe

...+++

Prayers for peace for you and yours.

Agreed. If the patient has the mental capacity to understand what's going on, and is capable of signing something (consent, waiver, whatever) proving that he/she requested a lethal overdose, then I'd have no problem with allowing patients to choose their own time to go.

What I would object to is intentionally killing a patient who is unable to express such wishes. At most there, one could rely on an advance directive that said "withhold care, keep me out of pain and let me die". Part of my practice is estate planning & this includes advance directives and other end-of-life planning. So it's a topic I've had to give thought to frequently.

Joe, this is NEVER an easy decision. I see family conflict all the time around how to care for loved ones who are getting too old to care for themselves. This is just my 0.02 and take it with a grain of salt because I do not know the complete family dynamic and I don't want to probe further into what you have shared. If there are those that do not like the idea of going into a nursing home, then they need to set up as a team and care for her with shifts and ensuring she has 24/7 care. It sounds like she is past the point of caring for herself on her own. Those that do not want to care for her, and would rather her be in a home, then should try and help out in other ways like just stopping by and to give the others a break or run errands for the other family members that are caring for her. I always try and remind my patients family members that they are family. They grew up together, they were raised by their lovely parents and ultimately it is now time for you all (the family) to come together and ensure the proper care is provided for your parents. There is no question that each individual opinion isn't based out of love, so its time to find common ground and remain together.

It's not easy, I know its not. With all 3 of the family members that we brought home and helped pass, it was hard. There were frustrating moments, and MANY of them. I will never forget when my grandfather was on his death bed and dying of COPD, my dad called freaking out saying he couldn't get his oxygen up and his concentrator was maxed out. He said he was gasping and despite giving him meds, he wanted to try and ease his breathing. I told him to turn the oxygen down. Talk about watching your own father about come unglued not understanding, thinking I am asking him to kill his own father. I couldn't even get a word in to try and explain logic because he became instantly irate when I told him to turn it down. I let him call me names, curse, yell, and cry before I could explain the difference in a COPD brain and a healthy brain and how the body strives for oxygen. Once I could explain, he understood and it worked, his oxygen got better, his breathing became easier and he was comfortable again.

I got pretty peeved when I got the call that it was my great grandmothers final moments and I needed to get right over. Drove over, she was in so much pain and she kept asking if these were her final moments. I held her hand, I put my other hand on her side so she knew I was there for her, and thats when I realized her bladder was beyond distended. I asked if she had urinated all day, and neither my grandmother or my father could say if she did or not. I told them, shes not dying shes just full. We called the home nurse, she came right out, had trouble starting the foley and so instead I started it on my great grandmother and when she emptied close to 800 ml out of her bladder, she went back to doing her crossword puzzle. I was pissed beyond belief that they thought she was dying and couldnt keep her comfortable but couldn't pay enough attention to the fact she hadn't used the bathroom all day. Let it go, left it alone, moved on as a team.

At the end of the day though, its tough, and it is always hard to watch it Joe, but no matter how ugly family becomes with each other, you all need to come together and try your absolute best to figure it out. All sides and families need to learn to give in a little to find common ground. Don't let it get to the point of never talking again. Deep down, neither of your parents would ever have wanted that for any of their children, and I am sure ALL of you know that. Keep being the peace keeper, don't let opinions get you down, always be there for your parents while they are still around, enjoy every single moment you can with them. Nothing lasts forever, but you can always continue to make memories in any way as long as they are here, even when your mom is having a really rough day.

^^^^^^^

Agree with this 100%.

Circumstance permitting, the patient being at home will almost always be more comfortable. Hospice is wonderful in helping the family understand where the patient is and what to expect in the future.

We did this with my Mother who died of lung cancer. In the end....we had her on a Morphine drip with the ability to Bolus and three of us family members took turns watching and caring for her 24 hours a day...the last two weeks of her life. I was holding her hand when she drew her last breath and it slowly rattled out.

But I know for certain she passed in comfort and that her Doctor, Hospice and family did everything possible to help Her pass peacefully.

My Daughter is an RN and relates similar struggles and thoughts as the OP. Its a tough job.

My wife passed after a battle with cancer at 40. Her last 5 or 6 days were in the hospital surrounded by an amazing team of nurses. The cancer had spread to her brain, and the last several days she wasn't there. No machines keeping her alive, just her body refusing to let go well past the time her conscious mind had gone to rest. We considered hospice, but found that the nursing staff had accomplished everything we could have hoped for, and knew at that point she wouldn't have known that we'd taken her home. The nurses invited us to stay as long as we wished.

They did an amazing job, as I'm sure you do, keeping her comfortable. Several times they came in to give her the medicine the doctor ordered and said "This may hasten her time here." and waited for us to acknowledge. That's all we could have asked for. She, as we knew her, was already gone. If it wasn't for folks like you, with the experience and knowledge to help guide us, we wouldn't have been able to prepare, make the best choices we could, and ultimately watch her transition knowing that her earthly body was comfortable. Having gone through it I know, if I'm given similar circumstances, I'll enjoy as much of my time as I have remaining before I walk my own path to keep my family and friends from going through what we did. But I take comfort in knowing that there's people like you who actually care and will be there for my friends and family if for some reason I don't get to make that choice.

That you took the time to express your struggles shows you have a soul meant for helping others. Whatever your doing, you're doing it well, and the world is a better place for it.

Very sorry to hear of this. I've seen the same thing happen to other families.

I can tell you unequivocally.....there are things worse than death. You seem to realize that already.

Never feel guilty for wanting a quick passing of a loved one. It is born of love that you would want that for them....and if they had any control over it themselves, would want to pass as easily as circumstance permits.

My prayers for you and family. I hope the difficult times you are all going though now will not drive a wedge between one another or cause anyone to do or say anything irreparable.

true this

I'm sorry to hear that, Sir. I'll say a prayer for peace for you and your family.

I will also say a prayer that your family can come together during this difficult time. Best wishes, Joe.

Thank you all for sharing. My little sister passed from leukemia at 25, it was hard on everyone, but I am thankful for the care she received from people like the OP.

To the OP, just take solace in the fact you are helping people. Try not to let your personal emotions get in the way. You are doing a job to serve people and families in their most difficult and vulnerable times. I hope you can find peace in your work and know that your heart for helping people is appreciated.

Thanks and blessings to all.

...+++

A sincere thanks to you flashman252 for the care you, and others like you, give. My mother had bone cancer which is painful. I had POA and she was clear that she did not want to suffer and wanted DNR. My youngest brother and I were holding her hands when she passed and thankfully it was peaceful. It's a difficult situation and, fortunately, my mother insisted on discussing it with me on many occasions so there was no doubt of her wishes.
Bless you caregivers.

Six years ago at this time I was in this situation with my wife and the nurse in the hospital and I believe we saw my wife die on Christmas Eve. She called the Dr and he checked her and she had a very faint heart beat and O2 level was like 13% so she was still with us and he said to just talk to her which I did and she decided it wasn’t time yet. The decision had already been made to bring her home on hospice for end of life care which we did on the 26th. The hospice nurse looked at her and all the records and said that it wouldn’t be long and we removed all medication that she was normally taking

Well we were on hospice for three months which there is an evaluation to see if the patient has improved or is still the same and will remain on hospice. I knew I think after about two or three weeks we would be removed from hospice after she had a BM and her coloration changed she had been jaundiced and they didn’t know what was causing it.

I was lucky that my BIL agreed with the decision that I had made with the DNR in the hospital and the end of life care at home. The Dr in the hospital would not tell me what to do and I understand this as they are in the practice of trying to heal. However, when I told him my decision he said it was the right thing to do as you had to think of the quality of life for the person.

We are now six years from that and 11 years into this Alzheimer’s journey and she is still not taking any medication. Her Primary Dr doesn’t understand how we are still on this journey and just tells me to keep doing what I’m doing. He and I have made the decision to no longer do bloodwork or any test because as he said “what are we going to do if we find something” the cure would be worse.

I think some families that are in an end of life situation are just really overwhelmed with the situation and is why the act as they do. As for me I will use the DNR again when it is needed and will request the medication to keep her comfortable but not to speed it up or hasten it.

There are times that I pray to God asking that he take her and then wonder if I am making this request for her to make her whole again or is it for me so I can have some type of life again.

As to the OP thank you for you caring I don’t know how you, the hospice nurse, and the other nurses deal with seeing and handling death on a regular basis.

You are a very strong person.

Easy to be of one accord when dealing with the Spectre of Death. It's pretty much universal. Don't know how you could put any 'spin' on that.

But, yes....beats the heck out of arguing.

Personally, I want to be sharp as a tack. I've seen too many times people with dementia or Alzheimer's and I believe the constant confusion, lack of memory and not knowing what is real and what is not....is torturous to them.

A person with all their mental faculties may 'stress' over the thought of impending death or may not, just depends on the person. But being mentally compromised is surely hard for not only the person suffering from it...but the family as well. How can there be a winner there?

Only being placed in a medical coma are you sure to not know anything. Dying in your sleep the next best thing.

For the family member caretakers, it's ok to feel relief when our loved ones pass. I did. I felt relief for Jennifer as she was no longer in pain, but also for myself. It's exhausting taking care of a terminally ill loved one. Exhausting. And anyone, family member or otherwise, who tries to guilt-trip you about feeling relieved can go pound sand. Go walk a day in our shoes, then come back and talk to me.